VP, Payment Integrity Ops

At Claritev, we pride ourselves on being a dynamic team of innovative professionals. Our purpose is simple - we strive to bend the cost curve in healthcare for all. Our dedication to service excellence extends to all our stakeholders – internal and external - driving us to consistently exceed expectations. We are intentionally bold, we foster innovation, we nurture accountability, we champion diversity, and empower each other to illuminate our collective potential. Be part of our amazing transformational journey as we optimize the opportunity towards becoming a leading technology, data, and innovation voice in healthcare. Onward and Upward!!! JOB SUMMARY: This role is accountable for being a thought leader responsible for managing the recovery process for our clients and developing strategy for the group. This position is responsible for claims recovery production, quality, and outward facing client communication and reporting. The role will focus on understanding and developing methodologies around improving the client experience and analytics, while managing process design, planning, system function design and continuous improvement programs. JOB ROLES AND RESPONSIBILITIES: 1. Drives department strategy though continued innovation; scales operations functions to support department growth and drive efficiencies; achieves department revenue and margin goals; develops and report key metrics internally and to clients. 2. Directs efforts of directors, managers, supervisors and individual contributors to ensure the completion of work in support of strategic initiatives; develops and directs procedures and methods to ensure that both client and company standards are met and maintained. 3. Measures, reports and forecasts operational performance; leads and directs the creation, maintenance and improvement of measurement systems to monitor the effectiveness of business process improvement initiatives and the impact on financial performance metrics. Completes problem analysis and problem resolution at both functional and strategic levels. 4. Determines staffing requirements; directs the interviewing, selection, and training/development process consistent with company standards. Engages and empowers employees to enhance the value of service provided to clients and customers. Scales the operational team to support company growth. 5. Establishes and implements department goals, policies and procedures in order to meet internal and external service level agreements. 6. Promotes a culture of excellence and client satisfaction by engaging and empowering employees. 7. Established and executes against new solution roadmap; provides insights and requirements to determine enabling technology requirements. Collaborates, coordinates and communicates across disciplines and departments. 8. Ensures compliance with HIPAA regulations and requirements. 9. Demonstrates company's core competencies and values held within. 10. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary. JOB SCOPE: This role works under minimal supervision and is afforded a wide span of influence across the department landscape. Work performed within the role will likely often be varied and complex in nature. The incumbent will work to develop and maintain strong iter/itra-departmental relationships amongst all organizational levels. This is a people management job with authority for all HR actions (hiring, firing, discipline, training, etc.). Job Requirements: JOB REQUIREMENTS (Education, Experience, and Training): Minimum Bachelor's Degree in a relevant field of stud along with seven (7) years' progressive experience specific to process improvements and operational excellence; MBA or other relevant advanced degree is highly preferred Deep knowledge of department solutions: COB, Data Mining, Clinical Audit and Premium Restoration Experience with project management, coaching, quality management, driving results, developing standards, and fostering teamwork. Proven experience in a role requiring budget management and oversight. Experience in driving business process in a growing organization Required licensures, professional certifications, and/or Board certifications as applicable Advanced knowledge of Microsoft Word, Excel and Outlook. Strategic thinking and planning. In-depth knowledge of key performance indicators. Assertive; results-oriented. Great organizational, time management and analytical skills. Strong oral and written communication skills. Motivational skills including coaching and mentoring. Strong relationship building skills. Strong leadership, decision-making, communication, and negotiation skills. Ability to travel as needed. Individual in this position must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier and telephone. COMPENSATION (EXTERNAL JOB DESCRIPTION ONLY) The salary range for this position is $150-170K. Specific offers take into account a candidate’s education, experience and skills, as well as the candidate’s work location and internal equity. This position is also eligible for health insurance, 401k and bonus opportunity. REQUIREMENTS [Copy this directly from JD, including any edits from the hiring manager] BENEFITS We realize that our employees are instrumental to our success, and we reward them accordingly with very competitive compensation and benefits packages, an incentive bonus program, as well as recognition and awards programs. Our work environment is friendly and supportive, and we offer flexible schedules whenever possible, as well as a wide range of live and web-based professional development and educational programs to prepare you for advancement opportunities. Your benefits will include: Medical, dental and vision coverage with low deductible & copay Life insurance Short and long-term disability Paid Parental Leave 401(k) + match Employee Stock Purchase Plan Generous Paid Time Off Paid company holidays Tuition reimbursement Flexible Spending Account Employee Assistance Program Summer Hours EEO STATEMENT Claritev is an Equal Opportunity Employer and complies with all applicable laws and regulations. Qualified applicants will receive consideration for employment without regard to age, race, color, religion, gender, sexual orientation, gender identity, national origin, disability or protected veteran status. If you would like more information on your EEO rights under the law, please Job Snapshot Employee Type Full-Time Location USA (Remote) Job Type Management Date Posted 02/25/2025